Temporal Changes in Pediatric Gastroenteritis after Rotavirus Vaccination in Quebec

Doll, Margaret K.; Gagneur, Arnaud; Tapiéro, Bruce; Charest, Hugues; Gonzales, Milagros; Buckeridge, David L.; Quach, Caroline

doi:10.1097/inf.0000000000001077

Cited by 29 publications

(15 citation statements)

References 51 publications

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“…During the study period, norovirus infection was the leading cause of AGE in hospitalized children, exceeding rotavirus infection. This has been observed in several recent studies from various countries after implementing rotavirus vaccination ( 1 21 22 23 ). The prevalence of adenovirus was also relatively high compared with that reported by previous Korean studies from the pre-vaccine era, which enrolled hospitalized children ( 16 24 25 ).…”

Section: Discussionsupporting

confidence: 59%

Epidemiology and Factors Related to Clinical Severity of Acute Gastroenteritis in Hospitalized Children after the Introduction of Rotavirus Vaccination

et al. 2017

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We aimed to investigate epidemiology and host- and pathogen-related factors associated with clinical severity of acute gastroenteritis (AGE) in children after rotavirus vaccination introduction. Factors assessed included age, co-infection with more than 2 viruses, and virus-toxigenic Clostridium difficile co-detection. Fecal samples and clinical information, including modified Vesikari scores, were collected from hospitalized children with AGE. The presence of enteric viruses and bacteria, including toxigenic C. difficile, was detected by polymerase chain reaction (PCR). Among the 415 children included, virus was detected in stool of 282 (68.0%) children. Co-infection with more than 2 viruses and toxigenic C. difficile were found in 24 (8.5%) and 26 (9.2%) children with viral AGE, respectively. Norovirus (n = 130) infection, including norovirus-associated co-infection, was the most frequent infection, especially in children aged < 24 months (P < 0.001). In the severity-related analysis, age < 24 months was associated with greater diarrheal severity (P < 0.001) and modified Vesikari score (P = 0.001), after adjustment for other severity-related factors including rotavirus status. Although the age at infection with rotavirus was higher than that for other viruses (P = 0.001), rotavirus detection was the most significant risk factor for all severity parameters, including modified Vesikari score (P < 0.001). Viral co-infection and toxigenic C. difficile co-detection were not associated with any severity-related parameter. This information will be helpful in the management of childhood AGE in this era of rotavirus vaccination and availability of molecular diagnostic tests, which often lead to the simultaneous detection of multiple pathogens.

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Section: Discussionsupporting

confidence: 59%

Epidemiology and Factors Related to Clinical Severity of Acute Gastroenteritis in Hospitalized Children after the Introduction of Rotavirus Vaccination

et al. 2017

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“…Viral GIs were a significant problem in the paediatric department, similarly to the work by Jackowska and Pawlik [ 18 ], where the proportion of viral healthcare-associated infections amounted to 96% of all infections. A comparable report from Quebec indicates a proportion of rotaviruses different from the studied one—20.4%, especially for noroviruses, 25.5%, in the aetiology of GIs [ 19 ] (in our study, it was respectively 60.2% and 16.4%), and concerns the population in which, for a couple of years now, vaccines against both viruses have been reimbursed—in Poland, these vaccinations are patient-paid and only recommended.…”

Section: Discussionmentioning

confidence: 41%

Hospital-Wide Surveillance of Healthcare-Associated Infections as a Source of Information about Specific Hospital Needs. A 5-Year Observation in a Multiprofile Provincial Hospital in the South of Poland

Kołpa

Wałaszek

Różańska

et al. 2018

IJERPH

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Healthcare-associated infections (HAIs) are adverse complications of hospitalisation resulting in delayed recovery and increased costs. The aim of this study was an analysis of epidemiological factors obtained in the framework of constant, comprehensive (hospital-wide) infection registration, and identification of priorities and needs in infection control, both with regard to targeted surveillance, as well as preventative actions. The study was carried out according to the methodology recommended by the HAI-Net (Surveillance Network) coordinated by the European Centre for Disease Prevention and Control, in the multiprofile hospital in Southern Poland, between 2012 and 2016. A total of 159,028 patients were under observation and 2184 HAIs were detected. The incidence was 1.4/100 admissions (2.7/1000 patient-das of hospitalisation) and significantly differed depending on the type of the patient care: in intensive care units (ICU) 16.9%; in surgical units, 1.3%; non-surgical units, 1.0%; and paediatric units, 1.8%. The most common HAI was gastrointestinal infections (GIs, 28.9%), followed by surgical site infections (SSIs, 23.0%) and bloodstream infections (BSIs, 16.1%). The vast majority of GIs, BSIs, urinary tract infections, and incidents of pneumonia (PN) were detected in non-ICUs. As many as 33.2% of cases of HAI were not confirmed microbiologically. The most frequently detected etiologic agent of infections was Clostridium difficile—globally and in GI (49%). Comprehensive analysis of the results allowed to identify important elements of surveillance of infections, i.e., surveillance of GI, PN, and BSI not only in ICU, but also in non-ICU wards, indicating a need for implementing rapid actions to improve compliance with HAI prevention procedures.

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“…Thus, inclusion of these participants may underestimate rotavirus vaccine coverage (as well as VE). While we cannot rule out inclusion, it is unlikely that influenza was predominantly responsible for nonrotavirus gastroenteritis in our sample for several reasons: approximately 40% of participants tested positive for alternate, nonvaccine-preventable gastroenteritis etiologies, norovirus or sapovirus [9]; we did not test for other pathogens characterized as significant contributors of pediatric acute gastroenteritis [33][34][35]; and among children with influenza, gastroenteritis is not a predominant clinical presentation, with <33% of cases experiencing diarrhea or vomiting symptoms [36][37][38][39][40] and <5% presenting with gastroenteritis as the cause of admission [36,39].…”

Section: Discussionmentioning

confidence: 99%

“…The assumption is also likely satisfied since there is no basis for the vaccine to provide immunity for nonrotavirus etiologies. Further, no association to date has been detected between rotavirus vaccination and absolute risk of norovirus [20,21], the leading cause of medically attended pediatric gastroenteritis in the post-rotavirus vaccine era [9,22,23].…”

Section: Underlying Assumptionsmentioning

confidence: 99%

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Two Birds With One Stone: Estimating Population Vaccination Coverage From a Test-negative Vaccine Effectiveness Case-control Study

et al. 2016

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Vaccination program evaluation includes assessment of vaccine uptake and direct vaccine effectiveness (VE). Often examined separately, we propose a design to estimate rotavirus vaccination coverage using controls from a rotavirus VE test-negative case-control study and to examine coverage following implementation of the Quebec, Canada, rotavirus vaccination program. We present our assumptions for using these data as a proxy for coverage in the general population, explore effects of diagnostic accuracy on coverage estimates via simulations, and validate estimates with an external source. We found 79.0% (95% confidence interval, 74.3%, 83.0%) ≥2-dose rotavirus coverage among participants eligible for publicly funded vaccination. No differences were detected between study and external coverage estimates. Simulations revealed minimal bias in estimates with high diagnostic sensitivity and specificity. We conclude that controls from a VE case-control study may be a valuable resource of coverage information when reasonable assumptions can be made for estimate generalizability; high rotavirus coverage demonstrates success of the Quebec program.

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Temporal Changes in Pediatric Gastroenteritis after Rotavirus Vaccination in Quebec

Abstract: Norovirus infections were more prevalent than rotavirus infections among pediatric gastroenteritis cases hospitalized or seeking emergency care. Rotavirus cases were, on average, more clinically severe than norovirus cases among participants of the same age.

Cited by 29 publications

References 51 publications

Epidemiology and Factors Related to Clinical Severity of Acute Gastroenteritis in Hospitalized Children after the Introduction of Rotavirus Vaccination

Epidemiology and Factors Related to Clinical Severity of Acute Gastroenteritis in Hospitalized Children after the Introduction of Rotavirus Vaccination

Hospital-Wide Surveillance of Healthcare-Associated Infections as a Source of Information about Specific Hospital Needs. A 5-Year Observation in a Multiprofile Provincial Hospital in the South of Poland

Two Birds With One Stone: Estimating Population Vaccination Coverage From a Test-negative Vaccine Effectiveness Case-control Study

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